Maternal and Child Health Nursing PDF

**A Framework for Maternal and Child** **Health Nursing** ------------------------------------ **GOALS AND PHILOSOPHIES OF MCHN** ------------------------------------ Comprehensive preconception and prenatal care is essential in ensuring a healthy outcome for mother and earth. Major Go...

**A Framework for Maternal and Child** **Health Nursing** ------------------------------------ **GOALS AND PHILOSOPHIES OF MCHN** ------------------------------------ Comprehensive preconception and prenatal care is essential in ensuring a healthy outcome for mother and earth. Major Goal of MCHN - **PROMOTION AND MAINTENANCE OF OPTIMAL FAMILY HEALTH.** MCHN extends from preconception to menopause with an expansive array of health issues and healthcare providers. ----------------------- **SCOPE OF PRACTICE** ----------------------- Preconception health care Care of women during three trimesters of pregnancy and the puerperium. Care of infants during the perinatal period. Care of children from birth through late adolescent. Care in a variety of hospital and home care settings. Family-centered approach is the preferred focus of nursing care. Note: The health of an individual and his or her ability to function as a member of a family can strongly influence and improve overall family functioning. Family-centered care enables nurses to better understand individuals and their effect on others and, in turn, to provide more holistic care. Family members are encouraged to provide physical and emotional care based on the individual situation and their comfort level. ----------------------------------------------- **MATERNAL CHILD HEALTH GOALS AND STANDARDS** ----------------------------------------------- Healthcare technology has contributed to a number of important advances in MCH care. New fertility drugs and fertility techniques allow more couples to conceive. The ability to prevent preterm birth and improve the quality of life for both preterm and late term infants has increased dramatically. Stem cell therapy may make it possible to replace diseased cells with new growth cells and cure these illness. -------------------------------- **2020 NATIONAL HEALTH GOALS** -------------------------------- The two main overarching national health goals are: **To increase quality and years of healthy life.** ** To eliminate health disparities.** A new objective added in 2010 recommends that 100% of pre licensure programs in nursing include core content on counseling for health promotion and disease prevention, cultural diversity including for LGBT populations, evaluation of health sciences literature, environmental health, public health systems, and global health. Help citizens more easily understand the importance of health promotion and disease prevention and to encourage wide participation in improving health in the next decade. **2000**: UN and the WHO established millennium health goals in 2000 in an effort to improve health worldwide. **2020**: National Health Goals, these concentrate on improving the health of women and children. ------------------------- **GLOBAL HEALTH GOALS** ------------------------- To end poverty and hunger. To achieve universal primary education. To promote gender equality and empower women. To reduce child mortality. To improve maternal health. To combat HIV/AIDS, malaria, and other disease. To ensure environmental sustainability. To develop a global partnership for development. -------------------------- **A FRAMEWORK FOR MCHN** -------------------------- **1**. **Nursing process** **2**. **Nursing theory** **3**. **Quality & Safety Education for** **Nurses (QSEN)** ----------------------------- **4 PHASES OF HEALTH CARE** ----------------------------- **1. Health promotion** educating parents and children to follow sound health practices through teaching and role modeling. **2. Health maintenance** intervening to maintain health when risk of illness is present. **3. Health restoration** using conscientious assessment to be certain that symptoms of illness are identified, and interventions are begun to return patient to wellness more rapidly. **4. Health rehabilitation** helping prevent complications from illness; helping a patient with residual effects achieve an optimal state of wellness and independence, helping a patient to accept inevitable death. --------------------- **NURSING PROCESS** --------------------- Nursing care is designed and implemented in a thorough manner, using organized series of steps. A scientific form of problem solving, serves as the basis for assessing, making a nsg dx, planning, implementing, and evaluating care. It is a process broad enough to serve as the basis for modern nursing care. -------------------- **NURSING THEORY** -------------------- One of the requirements of a profession (together with other critical determinants, such as members who set their own standards, self-monitor their practice quality, and participate in research) is that a discipline's knowledge flows from a base of established theory. **NOTE:** Nursing theories are designed to offer helpful ways to view patients so nursing activities can be created to best meet patient needs. **Examples:** **CALISTA ROY** An important role of the nurse is to help patients adapt to change caused by illness or other stressors. **DOROTHEA OREM** Examining patients\' ability to perform self-care **PATRICIA BENNER** Describes the way nurses move from novice to expert as they become more experienced and prepared to give interprofessional care. **Issues:** 1\. How nurses should be viewed or what the goals of nursing care should be. 2\. Extensive changes in the scope of MCHN have occurred as health promotion has become a greater priority in care. 3\. As promoting healthy pregnancies and keeping children well protects not only patients at present but also the health of the next generation. ---------- **QSEN** ---------- **Six Competencies of Quality Care** **1.** **Patient-centered care** **2. Teamwork and collaboration** **3. Quality improvement** **4. Informatics** **5. Evidenced-based practice** **6. Safety** **NOTE:** The overall goal is to address the challenge of preparing future nurses with the abilities necessary to continuously improve the quality and safety of the healthcare systems in which they work. ----------------------------- **EVIDENCE BASED PRACTICE** ----------------------------- Important element of nursing practice prior to the development of QSEN. The conscientious, explicit, and judicious use of current best evidence to make decisions about the care of patients. Combination of research, clinical expertise, and patient preferences or values. ---------------------------------------- **A MATERNAL AND CHILD HEALTH NURSE:** ---------------------------------------- 1. Considers the family as a whole and as a partner in care when planning or implementing or evaluating the effectiveness of care. 2\. Serves as an advocate to protect the rights of all family members, including the fetus. 3\. Demonstrate a high degree of independent nursing functions because teaching and counseling are major interventions. 4\. Promotes health and disease prevention because these protects the health of the next generation. 5\. Serves as an important resource for families during childbearing and childrearing as these can be extremely stressful times in a life cycle. 6\. Respect personal, cultural, and spiritual attitudes and beliefs as these so strongly influence the meaning and impact of childbearing and childrearing. 7\. Encourages developmental stimulation during both health and illness so children can reach their ultimate capacity in adult life. 8\. Assesses families for strengths as well as specific needs or challenges. 9\. Encourages family bonding through rooming-in and family visiting in maternal and child healthcare settings. 10\. Encourages early hospital discharge options to reunite families ASAP in order to create a seamless, helpful transition process. 11\. Encourages families to reach out to their community so the family can develop a wealth of support people they can call on in a time of family crisis. **ANATOMY AND PHYSIOLOGY OF THE REPRODUCTIVE SYSTEM** **MALE REPRODUCTIVE SYSTEM** **EXTERNAL STRUCTURES** **SCROTUM** - a rugated, skin-covered, mus- cular pouch suspended from the perineum. Its functions are to support the testes and help regulate the temperature of sperm. **TESTES** - stores sorerm and oroduce teststerone - two ovoid glands, 2 to 3 cm wide, that rest in the scrotum. Each testis is encased by a protective white fibrous capsule and is composed of a number of lob- ules. Each lobule contains interstitial cells (Leydig cells) that produce testosterone and a seminiferous tubule that produces spermatozoa. **PENIS** - serve as both the outlet for the urinary and reproductive tracts in men. **INTERNAL STRUCTURES** **EPIDIDYMIS** - responsible for conducting sperm from the tubule to the vas deferens, the next step in the passage to the outside. **Vas Deferens (Ductus Deferens)** - It carries sperm from the epididymis through the inguinal canal into the abdominal cavity, where it ends at the seminal vesicles and the ejaculatory ducts below the bladder. **Seminal vesicle** - These glands secrete a viscous alkaline liquid with a high sugar, pro- tein, and prostaglandin content. Sperm become increasingly motile because this added fluid surrounds them with a more favorable pH environment. **Prostate gland** - Secretes fluid that aids motility of the sperm - secrete a thin, alkaline fluid, which, when added to the secretion from the seminal vesicles, further pro- tects sperm by increasing the naturally low pH level of the ure- thra. **Bulbourethral Glands** - Secretes alakaline - or Cowper's, glands lie beside the prostate gland and empty by short ducts into the urethra. They supply one more source of alkaline fluid to help ensure the safe passage of spermatozoa. **Urethra** - a hollow tube leading from the base of the bladder, which, after passing through the prostate gland, continues to the outside through the shaft and glans of the penis. **FEMALE REPRODUCTIVE SYSTEM**  **Female External Structures** **Mons Veneris** - The mons veneris is a pad of adipose tis- sue located over the symphysis pubis, the pubic bone joint. Covered by a triangle of coarse, curly hairs, the purpose of the mons veneris is to protect the junction of the pubic bone from trauma **Labia Minora** - Just posterior to the mons veneris spread two hairless folds of connective tissue, the labia minora. Be- fore menarche, these folds are fairly thin; by childbearing age, they have become firm and full; and after menopause, they atrophy and again become much smaller. **Labia Majora** - serve as protection for the external genitalia; they shield the outlets to the urethra and vagina. Trauma to the area, such as occurs from childbirth or rape, can lead to extensive edema formation because of the looseness of the connective tissue base. **vestibule** - the flattened, smooth surface inside the labia. The openings to the bladder (the ure- thra) and the uterus (the vagina) both arise from this space. **clitoris** - a small (approximately 1 to 2 cm), rounded organ of erectile tissue at the forward junction of the labia minora. It's covered by a fold of skin, the prepuce; is sensitive to touch and temperature; and is the center of sexual arousal and orgasm in a woman. **FEMALE INTERNAL STRUCTURES** **Ovaries** - The function of the two ovaries is to produce, mature, and discharge ova (the egg cells). In the process of producing ova, the ovaries also produce estrogen and progesterone and initiate and regulate menstrual cycles. **Fallopian tubes** - Their function is to convey the ovum from the ovaries to the uterus and to provide a place for fertilization of the ovum by sperm. **Uterus** - The function of the uterus is to receive the ovum from the fallopian tube; provide a place for implantation and nourishment; furnish protection to a growing fetus; and, at maturity of the fetus, expel it from a woman's body. - Male has 2 types of sperm: androsperm and gynosperm Girl :XX Boy: XY - Male determine the gender of the child **Androsperm** - carries Y sex chromosome - Fast moving - Smaller, weaker, short lived dies in acid **Gynosperm** - carries X sex chromosome - Slower - Bigger, stronger, long lived - Acid resistant **Sperm** Volume: 2 to 6 ml Viscosity: liquid with 30 mins (20-30 mins) Sperm count: more than 20 million per ml **Emission** is the movement **Erection** is the first major component of the male sexual act **Ejaculation** is the forceful expansion **Analogous structure on the male and female reproductive** -------------------- ----------------------- **male** **female** **spermatozoa** **ovum** **glans penis** **llans clitoris** **scrotum** **labia majora** **penis** **vagina** **testes** **ovaries** **vas deferens** **fallopian tube** **prostate gland** **skene's gland** **cowper's gland** **bartholin's gland** -------------------- ----------------------- - Female sex drive is partially influenced by the testosterone like hormones and estrogen produced by the ovary - **Autonomic nerves** (regulate uncontrollable function or movement in our body) causes erectile tissue to become engorged with blood, the vestibular glands to secrete mucus, and the vagina to produce a lubricating fluid **PELVIS** **False pelvis -** superior half formed by the iliac , has two sides **True pelvis** - kabuuan **TYPES OF PELVIS** 1. Gynecoid 2. Android 3. Anthropoid 4. Platypelloid **MENSTRUATION** **MENSTRUAL CYCLE** - an episodic uterine bleeding in response to cyclic hormonal changes. - Purpose is to bring an ovum to maturity - 300,000 - 400,000 immature oocytes per ovary present at birth **Menarche** - first menstruation in girls **Menopause** - permanent cessation of menstruation; no more functioning oocytes in the ovaries - Normal period (days when there is menstrual flow) last for 3-6 days **Menstrual cycle** - from first day of menstrual period to first day of next menstrual period **Characteristics of Normal Menstrual Cycles** **Beginning (menarche)** - Average age at onset, 12.4 years; average range, 9-17 years **Interval between cycles** - Average, 28 days; cycles of 23-35 days not unusual **Duration of menstrual** **flow** - Average flow, 4-6 days; ranges of 2-9 days not abnormal **Amount of menstrual flow** - Difficult to estimate; average 30-80 ml per menstrual period; saturating a pad or tampon in less than 1 hr is heavy bleeding **Color of menstrual flow** - Dark red; a combination of blood, mucus, and endometrial cells **Odor** - Similar to marigolds **Associated terms** **Amenorrhea** - absence of menstruation **Dysmenorrhea** - pain during menstruation **Oligomenorrhea** - irregular menstruation **Menorrhagia** - abnormally heavy menstrual flows **Metrorrhagia** - Bleeding at irregular interval or Outside the cycle **Polymenorrhagia** - Frequent menstrual period and heavy bleeding **Body structures included** a. Hypothalamus b. Anterior pituitary gland c. Ovary d. Uterus **Effect of estrogen in the body** a. Inhibits production of FSH b. Causes hypertrophy of the myometrium c. Stimulates growth of the ductile d. Increases quantity and ph of cervical mucus, causing it to become thin and watery and can be stretch to a distance at 10-13 cm **Effects of progesterone in the body** a. Inhibits production of LH b. Increases endometrial secretions c. Inhibits uterine motility d. Decreases muscle line of gastrointestinal and urinary tract e. Increases musculoskeletal motility f. Facilitates transport of the fertilized ovum through the fallopian tube g. Decrease renal threshold for lactose and dextrose h. Increases fibrinogen levels; decreases hemoglobin and hematocrit i. Increases body temperature after ovulation. Just before ovulation, basal body temperature decreases slightly and then increases slightly a day after ovulation - When the ovary releases the mature ovum on the day of ovulation, sometimes a certain degree of pain in either the right or left lower quadrant felt by a woman called **Mittelschmerz** - The first 14 days of the menstrual cycle is a very variable period. The last 14 days of the menstrual cycle is a fixed period - In a 28 day cycle, ovulation takes place on the 14th day **Teaching about menstrual health** **Exercise** - Moderate exercise during menses promotes a general sense of well-being. Sustained excessive exercise, such as professional athletes maintain, can cause amenorrhea. **Sexual relations** - Not contraindicated during menses although the male should wear a condom to prevent exposure to body fluid. Heightened or decreased sexual arousal may be noticed. Orgasms may increase the amount of menstrual flow. It is improbable but not impossible for conception to occur from coitus during menses. **Activities of daily life** - Nothing is contraindicated (many people believe incorrectly activities such as running or bathing are harmful). **Pain relief** - Prostaglandin inhibitors such as ibuprofen (Motrin) are most effective for menstrual pain because they reduce inflammation as well as relieve pain. Applying local heat may also be helpful. If a migraine headache occurs, specific drugs for this are now available, such as sumatriptan (Imitrex). Adolescents under age 18 years should not take aspirin (acetylsalicylic acid) because of the association between this and Reye syndrome. **Rest** - More rest may be helpful if dysmenorrhea interferes with sleep at night. **Nutrition** - Many women need iron supplementation to replace iron lost during menses. Eating pickles or cold food does not cause dysmenorrhea. **CONCEPTION** **FERTILIZATION IMPLANTATION** **Fertilization** - the union of the sperm **Layers**: **Corona radiata** **Zona pellucida**-outer layer **Acrosome**- head of the sperm **Hyaluronidase** is the fluid that acrosome secretes that breaks the barrier of zona pellucida **Implantation** - occurs when the cellular wall of the blastocyst (the trophoblast) implants itself in the endometrium of the anterior or posterior fundal region, 7 to 9 days after fertilization - Primary villi appears within weeks after implantation - The trophoblast, in contact with the endometrial lining, proliferates and invades the underlying endometrium but separating and dissolving endometrial cells General consideration: 1. Normal amount of semen per ejaculation = 3-5cc or 1 teaspoon (20 million per ml) 2. Normal number of sperms in an ejaculate. = 120-150 million / cc 3. Mature ovum is capable of being fertilized for 12-24 hours after ovulation. Sperms are capable of fertilizing even for 3-4 days after ejaculation 4. Normal lifespan of the sperms= 7 days 5. Sperms once deposited in the vagina, will generally reach the cervix within 90 seconds after ejaculation 6. Reproductive cells during gametogenosis divide by meiosis (haploid number of daughter cells); they contain only 23 chromosomes. - sperms have 22 autosome and 1X sex chromosomes or 1Y sex chromosome - Ovarian contain 22 autosomes and 1X chromosome **ESSENTIAL PROCEDURES IN NORMAL PREGNANCY** **Estimating ovulation time** - estimate the exact time of ovulation in menstrual cycle is of utmost importance in maternity care. **Signs and symptoms** - abrupt slight increase in basal body temperature (0.3-0.5 C or 0.4-0.8 F), which is preceded by slight drop 24 to 36 hours before. The most fertile is 3-4 days before ovulation and 1-2 days after **Presence of Mittelschmerz** - the sensation of lower abdominal discomfort on the side of the ovary that ovulated - The irritation of the peritoneum by follicular or blood that escapes from ruptured Graafian follicle at ovulation cause mittelschmerz **Identification of Fertile Cervical Mucus** - brought about by the influence of the hormone estrogen. Fertile cervical mucus is characterized as: 1. Clear and transparent 2. Slippery and lubricative 3. Stringy, elastic and stretchable 4. Having a positive Fern Test 10-13cm stretch Ferning capacity or elasticity of cervical mucus increase, and viscosity decrease as ovulation approaches. The ferning test is also used to determine the rupture of amniotic membrane, in conjunction with nitrating test **Positive Spinnbarkeit Test** - The ability of the mucus to be stretched up. It exists where the mucus can be stretched at a minimum of 5 to. 6 cm as long as. 12 to 24 cm - Spinnbarkeit is a sign of Ovulation, the basis of one of the fertility awareness based on a natural methods of contraceptives called "Billing method" **What to include in menstrual history** - Menarche- first menstruation, occurs between 12 to 13 years of age - duration of menses - Presence of mittelschmerz - date onset of last menstrual period LMP - date of post or previous menstrual period PMP **HUMAN SEXUALITY** **Sexuality** - is a mutidimensional phenomenon that includes feelings, attitudes and actions - Gives direction to a responses thing life person's physical, emotional, social and intellectual. **Biologic gender** -- the term used to denote a person\'s chromosomal sex: male (XY), or female (xx) **Gender identity** -- Inner sense a person has of being male or female. **Gender role** -- male or female behavior a person exhibits. **DEVELOPMENT IN GENDER IDENTITY** - Infancy - Preschool period - School-age child - Adolescent - Young Adult - Middle-Age adult - Older adult **PUBERTY** - Physiologic Changes leading to development of adult reproductive capacity. - The process includes maturation of the hypothalamus pituitary gland and gonads. The pituitary secretion of gonadotropin initiates growth and maturation. It occurs initially during sleep and later in puberty throughout wakefulness. - In most girls, these changes are stimulated the H synthesizes and release Gn RH, which then trigger the anterior p to release FSH and LH. - FSH and LH are termed gonadotropin (gonad "ovary", tropin = "growth") hormones - mechanism that initiates pubertal change is not well understood. Combination of better nutrition and increase obesity, girls are beginning puberty at earlier than ages ever before (8-11 years of age). Studies of female athletes and girls with anorexia nervosa demonstrate that delays or halts in menstruation are r/t the lack of body fat or energy expenditure. **ADOLESCENCE** - Encompasses the physiological, social and cognitive changes leading to the development of adult identity. - Process includes individuation achievement of personal independence and maturation of cognitive reasoning skills. **THELARCHE** - Building of the breast **ADRENARCHE** - Development of axillary of pubic hair **TANNER STAGING** - Rating system for pubertal development **SEXUAL DEVELOPMENT** +-----------------------+-----------------------+-----------------------+ | Criteria | Male | Female | +-----------------------+-----------------------+-----------------------+ | Start growth Spurt | 3 y/o | After onset menses, | | | | | | | | 10 -- 12 y/o | +-----------------------+-----------------------+-----------------------+ | Growth rate | Rapidly early growth | Sharp decrease after | | | | menses | +-----------------------+-----------------------+-----------------------+ | Growth cessation | Early cessation | 12 yrs after onset | | | | menses | +-----------------------+-----------------------+-----------------------+ | Order sexual | 6 mos later than | 6 mos earlier than | | maturation | female. | male. | | | | | | | Complete 5 years. | Completed in 5 years. | +-----------------------+-----------------------+-----------------------+ | | First visible sign | Breast budding | | | darkening and | | | | thinning of scrotum | | +-----------------------+-----------------------+-----------------------+ | | Appearance of body | Increase size of | | | hair | pelvis | | | | | | | -Pubic area | | | | | | | | -Axilla | | | | | | | | -Upper lip | | | | | | | | -Face | | +-----------------------+-----------------------+-----------------------+ | | Penis grow, enlarge | Appearance of body | | | | hair | | | | | | | | \- Pubic area | | | | | | | | \- Axilla | +-----------------------+-----------------------+-----------------------+ | | "wet dreams" or | Menstruation | | | Nocturnal emmision | | +-----------------------+-----------------------+-----------------------+ | | Spermatogenesis | Ovulation | +-----------------------+-----------------------+-----------------------+ **HUMAN SEXUAL CYCLE** **Excitement** - Occurs with physical and psychological stimulation (sight, sound, emotion, thought) that cause parasympathetic nerve stimulation. The result of parasympathetic nerve stimulation nag kakaroon ng sudden gush of blood going to the reproductive system at yun ang nag c-cause ng increase vaginal lubrication, nag increase and daloy ng dugo going to different gland ng reproductive organ. Prostate gland and bulbourethral gland sa lalake nag I increase ng secreation kaya nagiging lubricated sa babae and titigas naman ang ari sa mga lalake. - Vaginal lubrication and vasocongestion of the genitalia. - Penile erection and scrotal thickening and elevation of the testes due to vasoconstriction. **Plateau** - *In women*: clitoral prepuce the lower part of the vagina becomes extremely congested (*formation of orgasmic platform due to prominent vasoconstriction*) and there is increased breast nipple elevation. - *In men*: distention of the penis. - Pre-ejaculatory phase with live spermatozoa - Generalized muscle tension, hyperventilation, increased BP, tachycardia in the late plateau phase. **Orgasm** - Occurs when stimulation proceeds through the plateau stage to a point at which a vigorous contraction of the muscles in the pelvic area expels or dissipated blood and fluid from the area of congestion. - Strong rhythmic contractions of vagina and uterus. - Muscle contraction surrounding the seminal vessels and prostate project semen into the proximal urethra. - Shortest stage in the SC. - Usually experienced as intense pleasure affecting the whole body, not just the pelvic area. **Resolution** \- A 30 minute period of relaxation stage during which the external and internal genital organs return to an unarousable state \- Rapid decline in pelvic vasocongestion. All organs return to an unarousable state. Men: a refractory period occurs during which further orgasm is impossible. Women: do not go through this refractory period, so it is possible for women who are interested and properly stimulated to have additional orgasm immediately after the first. **Refractory phase** - Only in males; the period during which no amount of stimulation can cause another erection. Not **THE INFLUENCE OF PREGNANCY ON SEXUAL RESPONSE** - **LP** - there is increased fluid retention and vasocongestion in the woman\'s lower pelvis. - **Vasocongestion** is already present at the beginning of the excitement stage of the sexual response, women appear to reach the plateau stage more quickly and achieve orgasm more readily during this time. - Pregnancy is another time in life when there is vasocongestion of the lower pelvis because of the blood supply needed by a rapidly growing fetus. Once na nagging pregnant ka out of sexual intercourse lagiing mag kakaroon na ngayon ng vasocongestion sa iyong lower pelvis kasi pine- prepare/ ni n- nourish ng ating circulation ang ating reproductive system kasi kasi kailangan yun at the same time may pinapalaki tayong baby or fetus kaya laging may vasocongestion sa ating pelvis especially sa pag dating ng pregnancy. - Many women continue to experience increased sexual interest because the new growth of blood vessels during pregnancy lasts for some time and continues to facilitate pelvic vasocongestion. Pag nag buntis, mag kakaroon ng mga bagong blood vessels kasi may growing fetus may a- attach dun sa ating uterus particularly ma d- develop ang placenta which is the connection between the mother and the baby. Kailangan magkaroon ng vasocongestion kasi dun mang gagaling ang supply ng nutrients going to the pelvis and going to the fetus. *Note* - At a time when a woman may want sexual contact very much, she needs to be free of myths and misconceptions, such as orgasm will cause a spontaneous miscarriage. - Increased breast engorgement that accompanies pregnancy results in extreme breast sensitivity during coitus. **TYPES OF SEXUAL ORIENTATION** **Heterosexual** - is one who finds sexual fulfillment with a member of the opposite gender. **Homosexual** - is a person who finds sexual fulfillment with a member of his or her. **Bisexuality** - people are bisexual if they achieve sexual satisfaction from both homosexual and heterosexual relationships. **Transsexuality** - or transgender person is an individual who, although of one biologic gender, feels as if he or she should be of the opposite gender.✩ **Celibacy** - is abstinence from sexual activity. Example of this are priest and nun. **Masturbation** - is self-stimulation for erotic pleasure; it can also be a mutually enjoyable activity for sexual partners. Women may find masturbation to orgasm the most satisfying sexual expression and use it more commonly than men. *What is the purpose of the PRIDE events that celebrate worldwide?* - They promote acceptance and equality while allowing people to express their identities freely. **TYPES OF SEXUAL EXPRESSION** **Erotic Stimulation** - is the use of visual materials such as magazines or photographs for sexual arousal. **Fetishism** - is sexual arousal resulting from the use of certain objects or situations. For example, sex toys. **Transvestism** - is an individual who dresses to take on the role of the opposite sex. For example, mga nag c- cross dressing. **Voyeurism** - is obtaining sexual arousal by looking at another person\'s body. For example, mga naninilip. **Sadomasochism** - involves inflicting pain (sadism) or receiving pain (masochism) to achieve sexual satisfaction. **Pedophilia** - are individuals who are interested in sexual encounters with children. **Exhibitionism** - revealing one\'s genitals in public. **ORGASM DISORDER** **Erectile Dysfunction** - formerly referred to as impotence, is the inability of a man to produce or maintain erection long enough for vaginal penetration or partner satisfaction. **Premature Ejaculation** - is ejaculation before penile-vaginal contact. **PAIN DISORDER** **Vaginismus** - is involuntary contraction of the muscles at the outlet of the vagina when coitus is attempted. **Dyspareunia/Vestibulitis** - is pain during coitus. - is inflammation of the vestibule. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ **Primary Sexuality** - Refers to the translation of social and cultural definition of femaleness and maleness, which will influence the kind of women or men children will grow up to be. Exposure of young kids dun sa cultural and social, influence kung magiging lalake sila or babae pag laki nila. **Affective Sexuality** - Incorporates all the experiences and dimensions related to closeness and intimacy with others. - It ranges from attraction - crushes, infatuation, love - to relationships -- Kung paano siya nagkaroon ng experiences dun sa mga taong nakakasalamuha niya where in nagkakaroon na siya ng kamalayan. **Genital Sexuality** - A broad range of biologically based experiences that activate the genital organs and influence genital activity. **-Common issues** - Masturbation - Wet dreams - Menstruation - Sexual performance anxiety - Orgasm - Impotence - Contraceptives - Pregnancy and abortion *Note:* - Ultimately, teaching about sexuality should lead to the cultivation of healthy attitudes toward one\'s own - Interestingly, no matter how \"educated\" one is, parents could be remiss in this aspect of a child\'s development. - It is most alarming at times to witness how parents are completely ignorant about the way they are affecting their children in this aspect. **Typical questions children ask** **Preschool** 1. How did the baby get in your tummy? 2. What\'s that (pointing to mom\'s breast)? Why is it bigger than mine? **ABOUT 6 TO 9** 1. How many times do people have to have intercourse to have a baby? 2. Why don\'t boys have breast? 3. Do boys have something like periods? 4. What are homosexuals? 5. How do you get twins? 6. Why can\'t we take baths together anymore? 7. How does the baby grow inside the mother? **ABOUT 10 TO 13** 1. How is sperm released into the female? 2. What are wet dreams? **AGE 14 AND UP** 1. What is the best birth control method? 2.. Is love a good reason to have sex? **Nursing Care Related to Psychological and Physiological Changes of Pregnancy** Maternal Adaptation to Pregnancy Physiologic Changes in Pregnancy **CARDIOVASCULAR SYSTEM** - Increased in blood volume of 30-50% (1500cc) at 3rd month contributes to increased cardiac workload. Sa ating circulation, remember na kapag nag buntis ang blood volume ay madadagdagan 30 to 50% which is equivalent to 1500cc -blood ang madadagdagan at ang ma p- produce ng katawan. For example, nung hindi pa buntis meron kang 4000 cc of blood kasi normal na blood volume in unpregnant estate id 4 to 5 litters of blood equivalent to 4000 and 5000 litters of blood, assuming dun sa state na hindi buntis may 4500 cc of blood this time na nag buntis sab isa cardiovascular system tataas ang blood volume ng 30 to 50% which is madadagdagan ng 1500 cc, now na ikaw ay buntis meron ka nang 6000ml of blood, kailangan natin mag produce additional blood kasi kailangan natin supply-an ng nutrients ang ating reproductive system at the same time kailangan natin supply-an ng nutrients ang lumalaking fetus or baby inside the womb, kung hindi mag I increase ng dugo during the pregnancy kukulangin ang mother ng dugo causing of anemia. - Mother feels fatigue (lassitude). - **Epistaxis** (or pagdurugo ng ilong) occurs due to hyperemia (pag matataas yung blood volume tataas din yung blood flow, increased of blood flow) of the nasal membrane. - Slight hypertrophy of ventricles. - Heart rate increases 10-15 bpm. Palpitation is also common. Increase of blood volume definitely increased of cardiac workload expect to increase the heart rate. - BP decreases in second trimester, rises to pregnancy level in third trimester. Kasi yung katawan nung mother nagiging at ease na pero pag dating ng trimester tataas ulit ang bp kasi nag p-prepare na sa birth of the baby. **Supine hypotension syndrome**: lying supine compresses the vena cava, blood return to the heart decreases. - Increased clotting factors, platelets, white blood cells, lipid, Decreased protein level. Can give meat for protein for the mother. - Occurs as a result of hemodilution of the blood. - 40-50% increase in blood volume expansion, (75% plasma, 25% RBC) Normal values in pregnancy: Hct: 32- 42%; Hgb: 10.5-14 d/dL **Pathologic Anemia** - IDA Idiopathic deficiency anemia - most common hematologic disorder. - S/Sx: pallor pangangatal, slowed capillary refill, concave fingernails (late sign) caused by chronic tissue hypoxia, constipation and listlessness. - Nutritional instruction: increased iron in diet. - Parenteral iron thru Z-tack method. - Oral iron supplements (ferrous sulfate 0.3g, 3x a day) -Edema Pamamanas of the lower is normal but edema in the upper extremities is a sign of pre-eclampsia (abnormal). **Varicosities** - can be prevented thru wearing of panty hose or support stockings. Pain of Vulvar varicosities is relieved thru positioning (side lying and modified knee-chest) There are 2 varicosities na pwedeng ma develop sa nanay na nag bubuntis, una normal varicoties na makikita sa legs, sa likod sa may alakalakan at sap aa, ma mamanage ito by asking the mother to wear a panty horse or stockings to support yung nag lalabasan na mga ugat para hindi pumutok. Pangalawang type ng varicosities ay vulvar varicosities location sa singit ng mother. **Thrombophlebitis or DVT deep vein thrombosis** - venous inflammation with thrombus formation - S/SX**: (+) Homan\'s sign**, Milk leg or **\"Phlagmasia Alba Dolens\"** - shiny white leg brought by stretching and inflammation of the skin.  A diagram of a body with veins Description automatically generated with medium confidence **ENDOCRINE SYSTEM** Responsible sap ag release ng hormones in our body at yung mga hormones sila yung isang nag c cause ng mga imbalances para tayo ay mag karoon ng balance in our everyday life. - Elevated HCG levels which reaches peak at third month then drops. - Estrogen and progesterone increase and continue to be secreted from the placenta during the last 6 months of pregnancy. Normally estrogen and progesterone ay ni r release sa ovary but since nag buntis this is the resting period of the ovary, walang activity si ovary. Pag dating ng third month ang placenta na ang nag r realese ng estrogen and progesterone hanggang sa mga susunod na buwan hanggang sap ag anak. - Progesterone acts to inhibit uterine contractions. Progesterone acts to inhibit uterine contractions dapat may presence ni progesterone kasi pag wala magkakaroon lagi ng uterine constraction may possibility na mawala ang baby. - Increase in both hormones leads to sodium and water retention and muscle relaxation which leads to fatigue. Always remember kung nasaan ang water nan dun din ang sodium kasi ***water attracts sodium*** kasi may retention ng water and sodium ito ang nagiging cause kung bakit nagkakaroon ng pamamanas ang mother, dahil namamanas ang mother nagkakaroon ng muscle relaxation kaya laging nakaka feel ng pagod na pagod. - Thyroid activity is increased; normal pregnancy may emulate a mild hyperthyroid state. - Estriol level increased; sometimes used as an indicator of fetal well-being. **RESPIRATORY SYSTEM** - The mother experiences SOB because of enlarging uterus and there is also an increased oxygen demand. - Hyperventilation hindi naiilabas ang carbondioxide occurs due to the mother\'s need to blow-off increased CO2 transferred to her from the fetus. - Nasal congestion occurs as a response to increased estrogen levels. **GASTROINTESTINAL SYSTEM** - Morning sickness - characterized by early morning N/V. 1st trimester morning sickness may be relieved by getting out of bed slowly after eating a few crackers, eating frequent, small meals (afternoon nausea), and by avoiding spicy or greasy foods. - Hyperemesis gravidarum ito yung sobra sobrang pagsusuka to the point in the verge of dehydration - Emesis gravidarum - Heartburn or Pyrosis - can be prevented by eating small frequent meals; avoiding fatty and spicy foods; - proper body mechanics; and taking sips of milk. - Decreased emptying time of gallbladder may precipitate development of gallstones. - Food cravings may occur; only significant if substance craved is unusual (pica). - Ptyalism - increased salivation - Hyperemia and softening of gums with accompanying hyperacidity of oral secretions result in nonspecific gingivitis. Flatulence-presence of excessive amount of gas in the stomach and intestines due to increased progesterone. **Constipation**- a condition in which bowel movements are infrequent or incomplete caused by hypoperistalsis, lack of fluids, poor dietary habits, pressure of the enlarged uterus on internal organ, effects of progesterone on muscles and hemorrhoids. Nag kaka constipation dahil walang masyadong peristaltic movement sa kanyang tiyan dahil lumalaki ang fetus so naiipit yung ibang mga organs. **Hemorrhoids almonaras**- a varicose condition of the external hemorrhoidal veins causing painful swelling at the anus. This is due to the gravid uterus. **RENAL SYSTEM** Resposnsible sa pag sala sa mga dumi ng tao this time na nag bubuntis mas marami ang trabaho kasi merong mga waste product si mother at the same time si baby may mga waste product din siya so nag d double ang filtering ni kidney nag o overload siya kaya ang renal nag kakaroon ng urinary frequency. - Proximity of the uterus and bladder in early and late pregnancy causes urinary frequency. (napapadalas ang pag ihi ni mother) - Bladder tone is reduced by effects of hormones on smooth muscles. - Pressure of enlarging uterus and the progesterone effect on smooth muscles cause dilatation of the uterus. - Kidneys increased in size because of the increase in renal blood flow. - Increased UO urine output (dalas ng pag ihi) results is lowered specific gravity. (bigat ng pag ihi) **Glycosuria** - determined by Benedict\'s test Determine the sugar in the urine **Nocturia**- waking up at night to pee **Proteinuria** - determined by Heat and Acetic Acid test Determine if there's a protein in the urine of the pregnant mother. **MUSCULOSKELETAL SYSTEM** **Lordosis** -- accentuation of the lumbar curvature of the spine. - Softening of all ligaments and joints. - Waddling Gait hindi matibay na pag tayo o pag lalakad ni mother - due to relaxin; risk for accidents **Leg cramps** - occur from an imbalance of calcium in the body and from pressure of the gravid uterus on nerves supplying the lower extremities. Kaya I m manage ito sa pag increase ng calcium. **INTEGUMENTARY SYSTEM** - Striae Gravidarum (Stretch marks) - Protruding Umbilicus - **Linea Nigra** - brownish-pinkish line running from symphysis pubis to the umbilicus separating the abdomen into right and left halves. - **Chloasma** - melanoderma or melasma, pigmented facial patches \"mask of pregnancy\" - Vascular spiders or telangiectasias - small, fiery-red branching spots) - Palmar erythema most of the time ang mga buntis ay nangangati ang kamay - Excretion of wastes through the skin causes diaphoresis.  **REPRODUCTIVE SYSTEM** - Amenorrhea occurs because the corpus luteum persists and ovulation is inhibited by the high levels of circulating estrogen and progesterone. - Changes in the uterus are circulatory, hormonal and related to fetal growth. - **Chadwick\'s sign** - bluish to purplish color of the cervix and vaginal mucosa. \"Leukorrhea\" - **Goodell\'s sign** - softening of the cervix - **Hegar\'s sign** - softening of the lower uterine segment - Uterus enlarges in size - Changes in position of the uterus +-----------------------------------+-----------------------------------+ | UTERUS | | +-----------------------------------+-----------------------------------+ | Length | Grows from approximately 6.5 cm - | | | 32 cm | +-----------------------------------+-----------------------------------+ | Depth | Increases from 2.5 cm to 22 cm | +-----------------------------------+-----------------------------------+ | Width | Expands from 4 cm to 24 cm | +-----------------------------------+-----------------------------------+ | Weight | Increases from 50 g to 1,000 g. | +-----------------------------------+-----------------------------------+ | Uterine wall | Early pregnancy: thickens from | | | about 1 cm to about 2 cm Toward | | | the end of pregnancy: thins to | | | become supple and only about 0.5 | | | cm thick | +-----------------------------------+-----------------------------------+ | Volume | Increases from about 2 ml to more | | | than 1,000 ml | | | | | | This makes it possible for a | | | uterus to hold a 7-lb (3,175-g) | | | fetus plus 1,000 ml of amniotic | | | fluid for a total of about 4,000 | | | g. | +-----------------------------------+-----------------------------------+ A diagram of a person\'s body Description automatically generated  **Ovaries** - pregnancy is the rest period for the ovaries. - Breast changes such as fullness, tingling, soreness, and darkening of the areola and nipples occurs with an increase in hormonal levels. **IMMUNE SYSTEM** - Immunologic competency during pregnancy decreases, probably to prevent a woman\'s body from rejecting the fetus. - IgG production is partially decreased, which can make a woman more prone to infection during pregnancy. - The changes in the various body systems give rise to the signs. and symptoms of pregnancy grouped into presumptive, probable, and positive signs. **PRESUMPTIVE** signs strongly suggestive of pregnancy; \"Could Be\" signs of pregnancy. **PROBABLE** - \"Probably Pregnant\" **POSITIVE** -- "Definitely Pregnant\" +-----------------+-----------------+-----------------+-----------------+ | | PRESUMPTIVE | PROBABLE | POSITIVE | | | | | | | | S/Sx are felt | S/Sx observed | Undeniable | | | and observed by | by the mother | signs confirmed | | | the mother but | and the members | by the use of | | | does not | of the health | instruments | | | confirm the | care team. | | | | diagnosis of | | | | | | | | | | pregnancy. | | | +-----------------+-----------------+-----------------+-----------------+ | 1st Trimester | -Breast changes | -Goodell\'s | Ultrasound | | | | | | | | -Urinary | Chadwick | Transabdominal | | | frequency | | | | | | \'s | Transvaginal | | | -Fatigue | | | | | | Hegar\'s | | | | -Amenorrh | | | | | | Elevated BBT | | | | ea | | | | | | Positive HCG | | | | -Morning | | | | | Sickness | | | | | | | | | | -Enlarged | | | | | uterus | | | +-----------------+-----------------+-----------------+-----------------+ | 2nd Trimester | Chloasma | Ballottement | FHT audible | | | | | | | | Linea Nigra | Enlarged | Fetal movement | | | | abdomen | | | | Increased | | Fetal outline | | | pigmentation | Braxton-Hick\'s | | | | | contraction | Fetal parts | | | Striae | | palpable | | | gravidarum | | | | | | | | | | Quickening | | | +-----------------+-----------------+-----------------+-----------------+ - Varied psychological responses due to hormonal changes, altered body image, anticipation of role changes, emotional makeup, socio-cultural background, and reaction of family and friends. - Common response includes ambivalence extremes emotion, grief, narcissism, introversion, stress and emotional liability. - Patient experience mixed feelings (even if the pregnancy was planned) due to unresolved emotional conflicts between the patient and her mother, fear of pending role change or of labor and delivery and the need to alter career plans. - Growing acceptance of the pregnancy as the patient sees her physical appearance change, experience quickness and hear fetal heart tones. - Focusing of woman\'s attention towards to self-preparation to birth - Normal response - May strain the relationship if her partner misinterprets introversion as rejection - Wide mood swing can strain marital or familiar relationships, possibly +-----------------------------------------------------------------------+ | 1st Trimester | +-----------------------------------------------------------------------+ | - Normal denial to confirmation of pregnancy. | | | | - Ambivalence about pregnancy, child, and parenting. | | | | - Mood swings or emotional liability. | | | | - Focusing on the self. | +-----------------------------------------------------------------------+ +-----------------------------------------------------------------------+ | 2nd Trimester | +-----------------------------------------------------------------------+ | - Acceptance of the baby as distinct from self; enhanced by | | quickening which is \"my baby is alive\" to the layman. | | | | - With fantasy and daydreaming. - Introspective; evaluates | | marriage, career, in-laws. | | | | - Most comfortable stage | +-----------------------------------------------------------------------+ +-----------------------------------------------------------------------+ | 3rd Trimester | +-----------------------------------------------------------------------+ | - Fear/anxiety/dreams about labor, pain, mutilation, and death. | | | | - Anxiety related to responsibilities. | | | | - Preparation for birth: nesting behavior; role- playing. | +-----------------------------------------------------------------------+ +-----------------------------------------------------------------------+ | Assessing Events That Could | | | | Contribute to Difficulty Accepting a Pregnancy | +-----------------------------------------------------------------------+ | -Pregnancy is unintended. | | | | -Learning the pregnancy is a multiple, not a single one. | | | | -Learning the fetus has a developmental abnormality. | | | | -Pregnancy is less than 1 year after a previous one. | | | | -Family has to relocate during pregnancy (involves a need to find new | | support people). | | | | -The woman has a role reversal (a previously support- ing person | | becomes dependent or vice versa). | | | | -The main family support person suffers a job loss. | | | | -The woman\'s relationship ends because of partner infidelity. | | | | -There is a major illness in self, partner, or a relative. | | | | -There is loss of a significant other. | | | | -Complications of pregnancy occur, such as severe hypertension. | | | | -The woman has a series of devaluing experiences such as failure in | | school or work. | +-----------------------------------------------------------------------+ **NURSING DIAGNOSES** diagnosis: soundless - Altered breathing patterns related to respiratory system changes of pregnancy - Disturbed body image related to weight gain from pregnancy - Deficient knowledge related to normal changes of pregnancy - Imbalanced nutrition, less than body - Powerlessness related to unintended - Possible impaired health and prenatal care behaviors associated with cultural beliefs - Patient states that she is able to continue her usual lifestyle throughout the pregnancy. - Family members describe ways they have adjusted their lifestyles to accommodate the mother\'s fatigue. - Couple states they understand the physiologic changes of pregnancy. **Essential for ensuring the overall health of newborns and pregnant patients** *A major strategy for helping to reduce complications of pregnancy* **Reasons for assessment** - Establish baseline of present health - Determine gestational age of fetus length of normal pregnancy: 280 days 42 weeks 9 calendar months 10 lunar months - Monitor fetal development and maternal well-being - Identify women at risk for complications - Minimize risk of possible complications by anticipating and preventing problems before they occur - Provide education about pregnancy, lactation, and newborn care **Schedule of Clinic Visits** [From first visit to 28 weeks:] **Every four weeks** [From 32 weeks to 36 weeks:] **Every two weeks** [From 36 weeks until delivery:] **Every week** **COMPONENTS OF PRENATAL VISIT**  **Maternal Medical and Obstetrical History** Personal information - Name, Address, Age, Civil Status, Occupation, religion, economic status, and educational level - History of emotional or psychiatric disorders - Diet practices Partner\'s History - Age - Genetic or medical disorders - Alcohol or drug use Medical History - Childhood diseases - Surgical procedures - Medical problems Family Medical History - History of multiple births, congenital diseases, or deformities - Significant medical problems Present Medical Status - Use of prescription and nonprescription drugs - Use of alcohol, tobacco, or illegal drugs - Conditions that could negatively affect pregnancy - Presence of disease, such as diabetes or cardiac disease Gynecologic History - Menarche - Length of menstrual cycle - Duration of menstrual flow - History of dysmenorrhea - Gynecologic surgeries Contraceptive use